危险因素聚集性与主要心脑血管事件发生风险的前瞻性队列研究  

A prospective cohort study on the clustering of risk factors and the risk of major adverse cardiovascular events

作　　者：张明 刘杰 涂青云 陈欣 覃玉[3] 向全永[3] ZHANG Ming;LIU Jie;TU Qing-yun;CHEN Xin;QIN Yu;XIANG Quan-yong(Pizhou Municipal Center for Disease Control and Prevention,Jiangsu Xuzhou 221300,China)

机构地区：[1]邳州市疾病预防控制中心,江苏徐州221300 [2]东南大学公共卫生学院 [3]江苏省疾病预防控制中心

出　　处：《江苏预防医学》2021年第6期649-653,共5页Jiangsu Journal of Preventive Medicine

基　　金：国家科技支撑计划(2011BAI11B01)。

摘　　要：目的探讨成人心血管疾病危险因素(cardiovascular risk factors,CVRFs)及其聚集性,与主要心脑血管事件(major adverse cardiovascular events,MACEs)发生的相关性。方法2010年采用PPS抽样调查邳州市≥18岁成年居民,于2011—2019年进行前瞻性队列随访研究,登记并核实MACEs事件(包括冠心病事件、脑卒中事件及其死亡)。将高血压、糖尿病、血脂异常、超重/肥胖和吸烟定义为CVRFs,采用Cox比例风险回归模型,探讨CVRFs及其聚集性与MACEs的相关关系。结果基线调查后,随访成年居民3022名,基线高血压、糖尿病、血脂异常、超重/肥胖、吸烟的检出率,依次为52.40%、8.14%、30.91%、52.93%、25.90%。截止到随访结束,共发生MACEs事件134例。调整混杂因素后,聚集5个CVRFs发生MACEs的风险是无聚集者的16.10倍(95%CI:4.80~54.07);高血压患者合并≥3个CVRFs时,MACEs发生风险是无聚集者的4.43倍(模型2,95%CI:1.57~12.54);糖尿病患者合并≥3个CVRFs时,MACEs发生风险是无聚集者的6.78倍(模型2,95%CI:2.35~19.55)。结论CVRFs的聚集与MACEs呈显著正关联,其中高血压和糖尿病是MACEs最为重要的危险因素,控制高血压和糖尿病对预防心脑血管疾病的发生及其死亡有重要意义。Objective To evaluate the associations between adult clustering of cardiovascular risk factors(CVRFs)and major adverse cardiovascular events(MACEs).Methods In 2010,adult residents aged at least 18 years old in Pizhou City were sampled by PPS method.A prospective cohort follow-up study was conducted from 2011 to 2019,MACEs were registered and verified(including coronary heart disease events,stroke events and death).The hypertension,diabetes,dyslipidemia,overweight/obesity and smoking were defined as CVRFs in this study.The Cox proportional hazards model was used to quantify the association between clustering of CVRFs with MACEs.Results After baseline survey,a total of 3022 participants were chosen for follow-up survey.The prevalence of hypertension,diabetes,dyslipidemia,overweight/obesity and smoking were 52.40%,8.14%,30.91%,52.93%and 25.90%,respectively in baseline survey.A total of 134 MACEs were recorded at the end of follow-up survey.After adjustment for confounders,compared with subjects with no clustering of CVRFs,participants with clustering of 5 CVRFs had 16.10-fold risk for occurrence of MACEs(95%CI:4.80-54.07),participants with hypertension combined with≥3 CVRFs had 4.43-fold risk of MACEs(Model 2,95%CI:1.57-12.54),diabetes participants combined with≥3 CVRFs had 6.78-fold risk of MACEs(Model 2,95%CI:2.35-19.55).Conclusion The clustering of CVRFs was positively associated with risk of MACEs.Hypertension and diabetes were the most important risks for MACEs.The control of hypertension and diabetes plays a key role in prevention of the future Cardiovascular disease incidence and mortality.

关 键 词：心脑血管疾病 危险因素 聚集 高血压 糖尿病 

分 类 号：R543[医药卫生—心血管疾病]